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MAFAC Research Meeting - September 2020

The September 2020 MAFAC Research Meeting was a unique meeting in that it provided quality discussions by the MAFAC Faculty on facial anatomy concepts that challenged traditional beliefs and anatomical teaching. It reflects the research activity that has been going on at the MAFAC Academy since the beginning of 2020.

Firstly, the preliminary findings on the deep plane -or fourth layer- of the face and neck was presented and debated intensively, causing a re-evaluation of the salivary glands, nerves and deep fat in relation to the deep fascia and the SMAS. Based on literature review as well as the preliminary cadaver dissections -and in contrast to traditional descriptions- the glands, facial nerve branches and facial vessels are suggested to be situated inside the fourth layer, not covered by the deep muscular fascia.

Secondly, the platysma and its relation to the deep fascia is investigated and reconsidered in the light of the findings of the fourth layer, causing a re-evaluation of the CMAS ligament, mandibular ligaments, Platysmal banding. Then, the segmental function and innervation of the platysma was subject to debate.

Lastly, various extra topics were discussed. The architectural built of the malar fat pad and its relationship to the nasolabial fold was presented as well as the various techniques of lifting it with analysis of the longevity, advantages and drawbacks of   each technique, which was never done before. Subsequently, the significance of the SMAS in the midcheek as well as its contribution to aging were discussed, as it is not clear whether the muscles of the SMAS and modiolus descend with aging or not. Then, the position and contributing volumes to the jowl were debated. Finally, the transverse facial artery perforator and the necessity/possibility of sparing this vessel in wide temple, midcheek and neck undermining cases was discussed.

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1 The Parotid Gland is in the Fourth Layer of the Face: Implications for the Facial Nerve

2 The Deep Fat Layer of the Face and Neck: Implications for Rhytidectomy

3 The Retaining System of the Face and Neck: Implications for Rhytidectomy

4 The CMAS Ligament: A Real Retaining Ligament or a Surgical Artifact?

5 The Mandibular Ligament versus the Platysma Attachment: Two Different Entities

6 The Platysma: An Anatomic and Functional Reappraisal

7 A Proposed Location for Platysma Denervation to prevent Recurrent Banding after Necklift

8 The Malar Fat Pad: Implications for the Nasolabial Fold

9 The Jowl: A Deep or Superficial Entity?

10 The SMAS in the Midcheek: Does it exist and is it surgically significant?

11 The SMAS, Mimetic Muscles & Modiolus: Do they descend with aging?

12 Can the Transverse Facial Artery be spared during surgery? A Clinical Report.

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